NPI age
19 years
Enumerated 2007-03-28
Across 1318 active internal medicine providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | G6081 | STATE LICENSE |
| 05 (TX) | 174691901 | |
| 01 (TX) | 90055463 | DPS REGISTRATION # |
| 01 (TX) | DB7452 | RAILROAD GROUP NUMBER |
| 01 (TX) | 0014GN | BLUE CROSS GROUP NUMBER |
Doing-business-as, former, and alternate names recorded by NPPES.
Single-site organization. Only one practice location on file.
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